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PREFACE The National Chamber Foundation, an affiliate of the Chamber of Commerce of the United States, is a public policy research organization founded in 1967 to provide in-depth analyses of critical economic and policy issues facing the nation. The Foundation's work includes gathering the best available information on selected issues, analyzing the impli- cations for the business community, and making recommendations for future public policy initiatives. Through this process the Foundation hopes to help society understand the value of the enterprise system in meeting economic and social needs and achieve the human goals that stem from a healthy economic environment. In line with these objectives and because of the lack of a comprehensive national health care delivery and financing strategy, the Foundation commissioned a study of the health care field as it relates to the business community. The National Chamber Foundation is in an ideal position to examine this important issue and to bring together the concerns and experience of several special interest groups to more fully examine the current debate and present alternatives for improving health care delivery. The objectives are to slow the rate of cost escalation without compromise to quality and to achieve adequate health care and health insurance protection for all Americans on an equitable, soundly financed basis that the nation can afford. The result of the study, a series of reports entitled A NATIONAL HEALTH CARE STRATEGY provides companies, associations, and communities with a practical guide for promoting and working toward those objectives. The specific topics include: O"How Business Interacts with the Health Care System (with a Special Action Plan for the Smaller Business)" p"How Business Can Use Specific Techniques to Control Health Care Costs" • "How Business Can Stimulate a Competitive Health Care System" • "How Business Can Promote Good Health for Employees and Their Families" • "How Business Can Improve Health Planning and Regulation" TIMN 0245681 Uu

EXECUTIVE SLW11LAR Y 11 Health promotion is a social movement of major proportions. It is gaining in popularity due to rapidly rising health care costs and to concern that health status in general is not improving even though an increasing number of dollars are being spent for health care. It has also gained attention as it becomes more and more apparent that lifestyle and negative health habits are associated with a decrease in the health status of many Americans. 0 The health promotion programs that business might undertake focus on educating consumers to adopt more healthful lifestyles and to become more prudent buyers of health care services. 0 The workplace may be a setting particularly well-suited to effective and widespread health promotion programs. Through the programs, businesses can help employees and their families achieve and maintain better health. The programs have the potential to benefit not only the individual participants, but also the sponsoring company through increasing productivity, reducing disability, lessening absenteeism, and lowering health care costs. O Before embarking on an effective course of health promotion, business must make two major perceptual and economic shifts: - from a passive to an active role in health care involvement - from support of expensive treatment-oriented health care to promotion of less costly, prevention-oriented programs Cost-benefit studies of health promotion programs are not easy to perform due to the difficulty of assigning monetary values to health outcomes and attributing specific benefits to specific programs. Carefully designed evaluations using control groups offer the best means of accurately measuring effectiveness, but this type of evaluation may not be feasible in many cases. With or without such experimental designs, establishment of an adequate company health data base may be the first step in conducting a meaningful evaluation of health promotion programs. 0 O Health promotion programs can be developed using in-house professional personnel, outside consultants, or a combination of both. Among the programs your company might consider are: Physical Fitness Smoking Cessation Alcohoh/Chemical Abuse Nutrition and Weight Control Screening Programs Accident Prevention High Blood Pressure Control Medical Self-Care Stress Management Wiser Buying of Health Care Services • Your firm can select appropriate health promotion programs based on an assessment of the needs and capabilities of your company as a whole, of individual employees, and of the community. Expectations for health promotion programs should be realistic; their ultimate value may lie as much in subjective as in objective benefits. • Health promotion programs, undertaken as one part of a compre- hensive health care strategy, have the potential to help control your company's health care costs, and perhaps equally as important, to improve individuals' productivity and quality of life both on and off the job. TIMN 0245683 '

A significant and positive de relopment in smoking control involves "Nonsmokers' Rights" activitics, which control smoking in public places and at the worksite. Efforts ar-~ also being made to eliminate or curtail cigarette advertising and to decrease the availability of cigarette vending machines in public places and company sites. Corporate managers interestei_l in curtailing the incidence of employee potential business smoking can begin by making --igarettes less available by, for example, solutions banning cigarette vending macl dnes and establishing more "no smoking" areas in offices and plants. Su, _h efforts can be coupled with courses on smoking cessation for individu: as who want to quit; the nearest branch of the American Cancer Society •;ould be of assistance in developing and implementing a program. Suggestions for Program Evaluation Outcome Measures. Prograun effectiveness can be measured by smoking cessation examining: [I number of employees wh_o sign up for a smoking cessation course O number of employees co.npleting a smoking cessation course and stopping smoking for a year or more 0 subjective comments and employee enthusiasm regarding the program • pre- and post program measures of.- - increased undersianding of the effects of smoking on long- and short-term h:mlth - number of smokuig employees (determined by survey) - number of cigarei ;es smoked per day per smoking employee (determined by survey) - number of cigarotte packs vended per month (a crude measure of consumption) programs: evaluation. Cost-Benefit Measures. Dec:reased smoking among employees should result in a reduction in re5 piratory infections (colds, sore throats, bronchitis, pneumonia, etc.) . If your absenteeism records classify illnesses by type, measure reductions in incidence of respiratory infections and translate the re:,,ulting lower absenteeism rates into dollar amounts. This will demonstrate some of the short-term savings to be expected from smoking cessation programs, but it will not indicate potential future savings from reductions in the incidence of cancer, heart disease, and emphysema. By using estimates, you should be able to generate overall cost-benefit ratios; a cost-benefit ratio of about 1:2 was calculated for one smoking ccssation program.=0 - Examples of Company Programs ... practical examples... • SPEEDCALL CORPORATION (electronics manufacturing plant, Hayward, California): Offers a $7 per week bonus for not smoking on the job (employees sign a contract to participate).=' • DEPARTMENT OF N :PALTH, EDUCATION AND WELFARE (Humphrey Office Building, Washington, D.C.): Ongoingprograms for smoking cessation and local Cancer Society IQ ("I Quit") chapter meetings held in the offices (employees who smoke are encouraged to attend). Potential Sources of More Information ... and resources OFFICE ON SMOHING !,ND HEALTH 5600 Fisher's Lane Rockville, Maryland 20857 301/443-1575 11 A National Health Care Si. ategy TIMN 0245685

E FOOTNOTES 1 The Fitness Mania. J. S. News and World Report; February 27, 1978. p. 39. 2 Braband, C. J.: Dev_ 4oping an Occupational Health Program. New York: Royal Indemnity Company; 1978. p. 48. 3 Follman, J. F., Jr.: 'i'he Economics of Industrial Health: History, Theory, and Practice. New York: AMACOM; 1978. p. 69. 4 Ibid. p. 73. 5 Ibid. 6 Some Thoughts on P, ~ssible Industrial Models of Preventive and Promotive Health. San Francisco, CA: Institute for the Study of Humanistic Medicine; October 1977. p. 1. 7 Follman, J. F., Jr.: op. cit. p. 179. 8 National Commissioa on the Cost of Medical Care 1976-1977, Volume 1. Commission Recommendations, Task Force Reports, Research Agenda. Chicago, IL: American Medical Association; 1978. p. 67. 9 Follman, J. F., Jr.: op. cit. p. 335. 10 LaLonde, M.: Canadg's Lifestyle Project. Medical Tribune; March 1, 1978. p. 7. 11 Somers, A. R.: Educ: .ting the consumer: it can mean better health, lower costs. American Medical News; May 27, 1974. p. 9. 12 Bond, M. B., Corpor=.te Medical Director, American Telephone and Telegraph, Basking Ridge, NJ, and member of National Health Care Strategy Steering Committee. Personal communication; September 14, 1977. 13 Belloc, N. B.: Relatitinship of Health Practices and Mortality. Preventive Medicine (2); 1973. pp. 67-81. 14 Belloc, N. B., and Br:.Wow, L.: Relationship of Physical Health Status and Health Practices. Preventive Medicine (1); 1972. pp. 409-421. 15 Farquhar, J. W., et ;1.: Community Education for Cardiovascular Health. Lancet (1); June 4, 1977. pp. 1192-1195. 16 Kier, S. C. A., Healt i Enhancement Council, Columbia, MD. Personal communication; December 2, 1977. 17 National Patterns of Cigarette Smoking 1972 and 1974. DHEW. Washington, D.C.: USGPO; 1976. 18 Smoking and Its Effeo.ts on Health. WHO Technical Report Series No. 568. Geneva, Switzerland: World Health Organization; 1975. p. 15. 19 Kristein, M. M.: Economic Issues in Prevention. Preventive Medicine (6); 1977. p. 256. 20 Ibid. p. 257. 21 Chafetz, M. E.: Second Special Report to the U. S. Congress on Alcohol and Health: New Knowledge. Washington, D.C.: USGPO; June 1976. p. xviii. 22 Follman, J. F., Jr.: og. cit. p. 87. 23 Follman, J. F., Jr.: Alcoholics and Business: Problems, Costs, Solutions. New York: AMACOM; 1976. p. 82. 24 Ibid. p. 84. 25 Strategy Council on i)rug Abuse: Federal Strategy for Drug Abuse and Drug Traffic Prevention. Washington, D.C.: USGPO; 1976. p. 3. 26 Dole, R., U. S. Senato r from State of Kansas. Hearings before the Select Committee on Nutrition and Human Needs of the U. S. Senate. Washington, D.C.: USGPO; February 1977. 27 Friend, B.: Changes in Nutrition in the U. S. Diet Caused by Alterations in Food Intake Patterns. Dietary Goals for the United States. The Select C)mmittee on Nutrition and Human Needs, U. S. Senate. Washington, D.C.: USGPO; February 1977. 28 Institute of Medicine: Perspectives on Health Promotion and Disease Prevention in the United States. Washington, D.C.: USGPO; January 19'78. p. 69. 29 Armstrong, B., and D i11, R.: Environmental Factors and Cancer Incidence and Mortality in Different Countries With Special Reference to Dietary Practices. International Journal of Cancer (15); 1975. pp. 613-617. 30 Winikoff, B.: Nutrition, Health and Public Policy. Submitted as testimony before the Senate Select Committee on Nutrition and Human Needs; ~,ugust 27, 1976. p. 10. 31 Burkitt, D. P., and T-owell, H. C. (Editors): Refined Carbohydrate Foods and Disease: Some Implications of Dietary Fibre. New York: Academic Press; 1975. p. 19. 32 Winikoff, B.: Diet Change and Public Policy. Prepared for Conference on Future Directions in Health Care: A New Public Policy, New York; Fcbruary 15-16, 1977. p. 7. TIMN 0245687 Health Pnnm.ntinn ct2

ma impact these measures as well. Thus, evaluating physical fitness pro~ams must out of necessity depend largely upon outcome measures. ... practical examples ... ... and resources smoking: an unh_ ealthy and expensive habit 0 B NNE BELL (cosmetic manufacturing and La ewood, Ohio): Offers a jogging program with out exe ise stations through woods and surroundin cise asses three times weekly; tennis lessons ~ and e ercise rooms with shower facilities /. P m a,m O SENTR INSURANCE COMPANY (Stev ns Point, Wisconsin): Provides 'ts over 2,000 employees with acilities that include a swimming ool, gymnasium, racquetb and handball courts, indoor driv g range, and a variety of ther exercise equipment. PRESIDENT'S C UNCIL ON P SICAL FITNESS AND SPORTS 400 Sixth Street S. , Room 30 0 Washington, D.C. 20 1 202/755-7947 Informs and assists the p 0 b,Mc in becoming physically fat. The Council issues numerous public Research Digest and U. S. Government Prin NATIONAL JOGG 919 18th Street N. 202/785-8050 Washington, D.C. ® ons including the Physical Fitness aV rbe an,U] IN 0 wsletter which are available through the ce. G ASSOCIATION X., Suite 83 0006 22 e A nonprofit ass ccation of joggers, the Association publishes a newsletter and The Jo ers Flash, a listing of p"ublications concerning jogging. AMERIC ASSOCIATION OF F S DIRECTORS IN B INESS AND INDUSTRY 400 S' Street S.W., Suite 3030 Was ' gton, D.C. 20201 FoVfzded in 1975 and an affiliate of the President's N ss and Sports, this association has over 500 hysically fit employees. orking to develop awareness among corporations SMOKING CESSATION uP Since 1964 when the Surgeon General of the U. S. Public Health Service issued a report on smoking and health, there has been increasing awareness of the important role of smoking in the development of chronic bronchitis, emphysema, coronary heart disease, peripheral vascular disease, and cancer of the tongue, esophagus, larnyx, lungs, pancreas, and bladder.17 Also, maternal smoking has been shown to have an adverse effect on unborn children by increasing the risks of complications such as prenatal death and retarded fetal growth.l$ In addition to posing a personal health risk to themselves and perhaps tc others, smokers cost themselves, their emp'_oyers, and their insurer: money. Persons who smoke one pack of cigarettes per day have a 50% greater rate of hospitalization and absenteeism than nonsmokers; twc packs per day doubles the absenteeism rate.ls TIMN 0245684 Health Promotion 1

InterStudy, an independcnt, Minneapolis-based health policy analysis and research firm headed ~by Paul M. Ellwood, Jr., M.D., was engaged by the Foundation to conduct the project. Nearly 40 foundations, corpo- rations, associations, and individuals are involved in supporting the project financially. In addition, the following Steering Committee, made up of individuals from th* business, insurance, and health care fields, furnished guidance for th~~ project: M. B. BOND, M.D. Corporate Medical Director American Telephone & Telegraph JOHN P. R. BUDLONG Senior Vice President - Operations ' American Management Associations JAMES L. CRAIG, M.D. Vice President, Corporate Medical Director General Mills Corporation MARTIIN' B. DANZIGER Director, United Mine Workers of Amet?. a Health & Retirement Funds - CARL DE MARTINO Assistant Director, Employee Relations Department E. 1. du Pont de Nemours & Co., Inc. ALAIN C. ENTHOVEN Marriner S. Eccles Professor Graduate School of Business Stanford University SCOTT FLEMING Senior Vice President Kaiser Foundation Health Plan WILLIS B. GOLDBECK Director Washington Business Group on Health ERNIE HONIG-KENT Director, Legislative Services Maryland Chamber of Commerce WALTER J. McNERNEY President, Blue Cross and Blue Shield Associations JOE D. MILLER Senior Vice President American Medical Association STANLEY R. NELSON Executive Vice President Henry Ford Hospital DAVID J. OTTENSMEYER, M.D. President & Medical Director Lovelace-Bataan Clinic JAN PETER OZGA - Associate Director. Health Care Chamber of Commerce of the United States E. LESLIE PETER Chairman & Chief Executive Officer Health Maintenance Organizations SISTER MARY ROCH ROCKLAGE, R.S.M. President - St. John's Mercy Medical Center JACK K. SHELTON Manager. Employe Insurance Department Ford Motor Company ROGER C. SONNEMANN Vice President AMAX ARMAND C. STALNAKER Chairman and President General American Life Insurance Co. EMMERSON WARD, M.D. Professor of Medicine, Mayo Medical School Former-Chairman, Board of Governors Mayo Clinic C. CRAIG WRIGHT, M.D. Director of Health Services Xerox Corporation V. M. ZINK Director, Employe Benefits and Overseas Industrial Relations General Motors Corporation Every effort has been mada to represent the interests of all segments of the health care field and to incorporate the issues identified by Steering Committee members. However, InterStudy is solely responsible for the content of this series and For any errors, oversights, and/or omissions contained in the reports. It is expected that the series will be revised periodically, and any cornTuents or additions are welcome. Throughout the development of this report, ideas and suggestions have been supplied by individu: ls and organizations too numerous to name individually, but to whom we extend our appreciation. Special thanks go to the following members o.' the InterStudy staff for their contributions: Lenore Kligman, Jan Malco lm, John Rosala, and Donna Welsh. Also, our thanks to the InterStudy secretarial staff, in particular Lori Nelson and Virginia Wayne, for their panstaking work on several drafts of the report. Finally, our appreciation to Martha Heiberg for her invaluable editorial assistance and supervision of the publishing of the series. „;::

k many in the work,`orce misuse alcohol ... or chemicals ... and identifi•ing TE'Sources potential solution.3 int;olve defining company policy ... Acts as a clearinghouse for the dissemination of information concerning health education, preventive health, and related matters on smoking and health; coordinates and promotes research on effects of smoking on health; and provides assistance for educational programs on smoking and health. NATIONAL CANCER INSTITUTE National Institutes of Health Bethesda, Maryland 20014 Established in 1937 as part of the Public Health Service, this is the federal government's principal agency for cancer research and preventive programs. The Institute's goal is the reduction and eventual elimination of cancer as a major health problem. o®t e N 0 0 em ® 3E a~ _ ' 0 a oa ra apu Employer-sponsored al holism programs h ve met with encouraging results. Because of the' workplace setting, the enhance an employee's desire to hold on to hi or her job and thus provid powerful incentive for successful resolutio of a drinking problem. i s 0 m Alcoho United S medical, ~ p devastating Furthermore, estimates place welfare services, buse is generally recognized as the major drug problem in the tes today, directly involving 10 million problem chological, and social consequences of alcq r the individuals who drink and those e economic cost of alcoholism is staggerin t at $25 billion annually in lost wor d accidents.21 It is estimated that a alcoholics or serious employee population employ. In 1974, alcoho billion a year, or $32 milli absent two and one-half t their accident rate for both high.23 North American Roe employee of more than $50, Angeles estimates an annual co employees at $1 million.24 Chemical abuse involves a wide amphetamines, cocaine, and oth prescription) and illegal ways. workplace, drug users general incidence of accidents, and sh similarity to alcohol abuse, same manner. The first step bring the probl policy. This p any unions i levels and it shoul treatme to avoi proximately 5 to 10% of the busers; extending this pe es an indication of how m was estimated to c each working day es as often as n- and off-th ell estima 0, and t of al developing an alcohol/chemical a into the open by developing a form icy must have the active support of top olved. The program should be available to e conducted on a confidential, individualized e made clear to alcoholic employees that re t will result in disciplinary action, every attempt shd appearing strongly coercive, paternalistic, or threa In most alcohol and drug abuse programs, employees with deteriorating job performance and evidence of chemical abuse are referred to TIMN 0245686 on's workforce are entage to your own y alcoholics you may t American business $8 Alcoholic employees are nalcoholic employees, and ob accidents is 3.6 times as s an annual cost per alcoholic nited California Bank of Los holism in a workforce of 10,000 ety of drugs (barbiturates, heroin, btained in both legal (that is, by not an extensive problem in the ent more often, have a greater d productivity.'-5 Because of its e can be approached in the use program is to written company anagement and mployees at all vel. Although sal to seek ld be made ning. Health Promotion 12

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